British Hypertension Guidelines (2004) Summary: Type II diabetes (1)
* if no evidence of nephropathy
o threshold for intervention with antihypertensive therapy is a BP >= 140/90 mmHg and the optimal blood pressure target is < 130/ <80 mmHg
+ with regards to this target then three additional points should be considered:
# control of hypertension, particularly systolic blood pressure (SBP) is more difficult in patients with diabetes
# in review of clinical trials, most have failed to achieve the target of <130/80 mmHg (particularly difficult to reduce SBP below 140 mmHg)
# control of diastolic blood pressure is less problematic and therefore the main focus should be on control of SBP as many of these patietns (particularly with type II diabetes) will have isolated systolic hypertension
* if nephropathy
o target blood pressure is < 130/80 mmHg, or lower (<125/75 mmHg) when there is proteinuria >= 1g/24h
o BP reduction and ACE inhibitors lead to a reduction in the rate of renal decline. There is also evidence that antihypertensive treatment with an ARB can delay the progression of microalbumnuria to overt nephropathy (proteinuria) and the progression to end-stage renal disease